Early-stage primary signet ring cell carcinoma of the colon

Primary signet ring cell carcinoma of the colorectum detected at an early stage is very rare; most cases are detected at an advanced stage. Therefore, its progno-sis is poorer than that of ordinary colorectal cancer. A 56-year-old Korean man was seen at this hospital for management of signet ring cell carcinoma of the co-lon. Colonoscopic examination revealed a Ⅱa-like, ill-defined and flatly elevated 9-mm residual tumor in the cecum. Endoscopic mucosal resection was preformed. Pathological examination of the resected specimen re-vealed signet ring cell carcinoma that had invaded the lamina propria without venous or perineural invasion. Abdominal computed tomography (CT) and positron CT showed no evidence of primary lesions or distant me-tastasis. An additional laparoscopic right-hemicolectomy was performed; no residual tumor or lymph node me-tastasis was found. We report a case of primary signet ring cell carcinoma of the colon detected at an early stage and provide a review of the literature.     

Primary rectal signet ring cell carcinoma with peritoneal dissemination and gastric secondaries

Disseminated signet ring cell carcinomas frequently arise from the stomach. However, primaries in the colon and rectum have also been reported. We present a 68 year old lady who presented with a change in her bowel habit. Colonoscopy showed a stenosing rectal tumour at 7 cm to 8 cm from the anal verge. Multiple scattered ulcers were also noted along the entire length of the colon. Biopsy of the lesions revealed signet ring cell adenocarcinoma. Gastroscopy showed multiple nodules with ulceration over several areas of the stomach which were similar in appearance to the colonic lesions. However, no primary tumour of the stomach was seen. Biopsy of the gastric lesions also showed signet ring cell adenocarcinoma. Computed tomography scan of the abdomen and pelvis revealed circumferential tumour at the rectosigmoid junction with possible invasion into the left ischiorectal fossa. The overall picture was that of a primary rectal signet ring cell carcinoma with peritoneal dissemination. The patient was referred for palliative chemotherapy in view of the disseminated disease. In the present report, we discuss this interesting pathological entity and review the role of various histolological techniques in helping to identify the primary tumor.     

Primary signet ring cell carcinoma of the appendix： A rare case report and our 18-year experience

Primary adenocarcinoma of the appendix is a rare malignancy that constitutes 〈 0.5% of all gastrointestinal neoplasms. Moreover, primary signet ring cell carc noma of the appendix is an exceedingly rare entity. We have encountered 15 cases of primary appendiceal cancer among 3389 patients who underwent appen- dectomy over the past 18 years. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastases and unresectable peritoneal dissemination occurring in a 67-year-old female patient. She underwent ap- pendectomy and bilateral salpingo-oophorectomy with a laparoscopy procedure. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-flurorouracil, and leucovorin （FOIFOX-4）. The patient currently is well without progression of disease 12 mo after beginning chemotherapy.     

Risk of cancer,with special reference to extra-intestinal malignancies,in patients with inflammatory bowel disease

AIM:To determine the incidence and characteristics of intestinal and extra-intestinal cancers among patients with inflammatory bowel disease in a Spanish hospital and to compare them with those of the local population.METHODS:This was a prospective,observational,7-year follow-up,cohort study.Cumulative incidence,incidence rates based on person-years of follow-up and relative risk were calculated for patients with inflammatory bowel disease and compared with the background population.The incidence of cancer was determined using a hospital-based data registry from Hospital Universitario de Fuenlabrada.Demographic data and details about time from diagnosis of inflammatory bowel disease to occurrence of cancer,disease extent,inflammatory bowel disease treatment,cancer therapy and cancer evolution were also collected in the inflammatory bowel disease cohort.RESULTS:Eighteen of 590 patients with inflammatory bowel disease developed cancer[cumulative incidence=3%(95%CI:1.58-4.52)vs 2%(95%CI:1.99-2.11)in the background population;RR=1.5;95%CI:0.97-2.29].The cancer incidence among inflammatory bowel disease patients was 0.53%(95%CI:0.32-0.84)per patient-year of follow-up.Patients with inflammatory bowel disease had a significantly increased relative risk of urothelial carcinoma(RR=5.23,95%CI:1.95-13.87),appendiceal mucinous cystadenoma(RR=36.6,95%CI:7.92-138.4),neuroendocrine carcinoma(RR=13.1,95%CI:1.82-29.7)and rectal carcinoid(RR=8.94,95%CI:1.18-59.7).Colorectal cancer cases were not found.CONCLUSION:The overall risk of cancer did not significantly increase in our inflammatory bowel disease patients.However,there was an increased risk of urinary bladder cancer and,with less statistical power,an increased risk of appendiceal mucinous cystadenoma and of neuroendocrine tumors.Colorectal cancer risk was low in our series.     

Ileocecal endometriosis and a diagnosis dilemma: A case report and literature review

Bowel endometriosis affects between 3.8% and 37% of women with endometriosis. The evaluation of symptoms and clinical examination are inadequate for an accurate diagnosis of intestinal endometriosis. We describe the case of a 41-year-old woman who presented to our hospital because of six months of recurrent abdominal pain, vomiting and diarrhea, without previous history of bowel disease. Physical examination revealed a palpable 3 cm × 5 cm mass in the right lower quadrant abdomen. Laboratory tests showed slightly elevated levels of CA19-9 and CA125. Small bowel computer tomography scanning revealed an ileocecal mass with bowel wall thickening and luminal narrowing. Small bowel endoscopy identified a deep longitudinal ulcer and mucosal edema in the distal ileum. All these findings supported the diagnosis of Crohn’s disease. The patient underwent a laparotomy, which identified a 5 cm × 5 cm ileocecal mass with severe mucosal edema and luminal stricture in the distal ileum. Histopathological examination confirmed a diagnosis of ileocecal endometriosis without other areas involved. After oneyear follow-up, there was no recurrence of the symptoms.     

Ectopic liver: Different manifestations,one solution

Developmental abnormalities are rare in the liver.This study presents two case reports of ectopic liver.The first case was a 31-year-old male with clinical indication for laparoscopic appendectomy.Laparoscopy identified a perforated appendix and an unknown tumorous lesion in the ligamentum hepato umbilicalis.The patient underwent a laparoscopic appendectomy,intraoperative lavage of the peritoneal cavity,and extirpation of the lesion in the ligamentum hepato umbilicalis.Histpathological examination of the excised tumor revealed that it comprised liver tissue with fibrinous changes.The tumor was completely separate from the liver with no connection.It was classified as an ectopic liver.No further therapy was required.The second case was a59-year-old male with a tumor on the upper pole of the spleen,incidentally diagnosed in an ultrasound examination.The biopsy raised suspicion of hepatocellular carcinoma.A positron emission tomography-computed tomography examination revealed accumulation of F-18 fluorodeoxyglucose only in the tumor.The patient underwent a splenectomy with a resection and reconstruction of diaphragm.After the hepatocellular carcinoma was confirmed,adjuvant therapy(sorafenib)was initialized.The operations and postoperative recoveries were uncomplicated in both cases.Despite the low incidence of ectopic liver and rare complications,it is necessary to maintain awareness of this possibility.The potential malignancy risk for ectopic liver tissue is the basis for radical surgical removal.Therapy for hepatocellular carcinoma in an ectopic liver follows the same guidelines as those followed for treating the"mother"liver.     

Emergency caudate lobectomy for ruptured hepatocellular carcinoma with multiple primary cancers

We report a case of metachronous multiple primary malignancies involving both rectum and liver with colonic metastasis from hepatocellular carcinoma(HCC) through hematogenous pathway.A 72-year-old woman was admitted to the emergency department with right upper abdominal pain for 4 h.Considering her surgical history of Mile’s procedure plus liver resection for rectal cancer with liver metastasis three years ago and the finding of urgent computed tomography scan on admission,the preoperative diagnosis was spontaneous rupture of rectal liver metastasis located in caudate lobe and colonic metastasis from rectal cancer. The patient underwent an emergency isolated caudate lobectomy at a hemorrhagic shock status.Pathology reported a primary HCC in the caudate lobe and colonic metastasis of HCC with tumor embolus in the surrounding vessels of the intestine.No regional lymph node involvement was found.It is hypothesized that HCC may disseminate hematogenously to the ascending colon,thus making it a rare case.     

Synchronous isolated splenic metastasis from colon carcinoma and concomitant splenic abscess： A case report and review of the literature

This study aimed to describe a case in which an isolated splenic metastasis was synchronous with the colonic primary and a concomitant splenic abscess was associated. A wide review of the literature was also performed. A 54-year-old woman with abdominal pain and fever was admitted to our department. Abdominal CT revealed two low-density areas in the spleen and wall-thickening of the left colonic flexure, which was indistinguishable from the spleen parenchyma. The patient underwent emergency celiotomy, with the presumptive diagnosis of obstructing colon carcinoma of the splenic flexure, and concomitant splenic abscess. Subtotal colectomy and splenectomy were performed. Pathological findings were consistent with mucinous colonic carcinoma, synchronous isolated splenic metastasis and concomitant splenic abscess. This paper is also a review of the existing literature on the association between colorectal cancer and splenic metastasis. Only 41 cases of isolated splenic metastasis from colon carcinoma have been reported in the literature. This report is the third described case of synchronous isolated splenic metastasis from colon carcinoma. Only one case with concomitant splenic abscess has been previously reported. When obstructing left-sided colorectal cancer is suspected, careful CT examination can allow early diagnosis of splenic involvement by the tumor. The literature review suggests that there might be a significant improvement in survival following splenectomy for a metachronous isolated splenic metastasis from colon carcinoma. Prognosis for synchronous splenic metastasis seems to be related to the advanced stage of the disease. Nevertheless, no definitive conclusions can be drawn because of the small number of cases.     

Emerging and under-recognized Chagas cardiomyopathy in non-endemic countries

Due to recent population emigration movements,an epidemic of Chagas disease is currently menacing most developed countries.The authors report the case of a 53-year-old Brazilian woman living in Europe for the last 10 years who developed heart failure symptoms,having a previous symptomatic sinus node disease with a pacemaker implant at age of 40 years.The diagnosis was based on serology and myocardial biopsy and the patient was treated with nifurtimox.The authors emphasize the need of a high level of suspicion in patients with suggestive epidemiology and the needof populational screening of specific high risk groups.New treatment options are also discussed.     

Minute signet ring cell carcinoma occurring in gastric hyperplastic polyp

We describe a 45-year-old woman with minute signet ring cell carcinoma occurring in a gastric hyperplastic polyp. A biopsy specimen obtained from the gastric hyperplastic polyp revealed signet ring cell carcinoma. Endoscopic mucosal resection （EMR） was performed to confirm the diagnosis. Histological examination of the EMR specimen revealed focal signet ring cell carcinoma in the hyperplastic polyp. There are few cases of gastric hyperplastic polyp associated with signet ring cell carcinoma.     

胃印戒细胞癌并肺癌性淋巴管炎1例报道

肺癌性淋巴管炎(pulmonary lymphangitic carcinomatosis,PLC)是一种少见的肺内转移癌,诊断困难,预后较差。本文就1例胃印戒细胞癌并PLC患者的诊治过程进行分析,为临床工作者提供参考,降低该病死亡率。     

Primary signet-ring cell carcinoma mimicking segmental Crohn''s colitis

Primary signet-ring cell carcinoma of the colon is a rare entity with a dismal prognosis, mainly due to a delay in diagnosis. Here, we present a case of a 30-year-old Filipino woman who presented with symptoms mimicking inflammatory bowel disease. A barium enema and colonoscopy demonstrated a stricture in the rectosigmoid region. A biopsy revealed granulomatous changes indicative of inflammatory bowel disease. Despite initial improvement of her symptoms on total parenteral nutrition and steroids, the patient relapsed several weeks later with recurrent left lower quadrant pain. A subsequent biopsy revealed poorly differentiated signet-ring cell carcinoma of the colon. She was treated surgically with a left hemi-colectomy and primary repair. A high degree of suspicion is necessary to correctly diagnose these, often young, patients with primary signet-ring cell carcinoma early and have a positive impact on survival. The literature on primary signet-ring cell carcinoma is reviewed.     

Diagnosis of colonic amebiasis and coexisting signet-ring cell carcinoma in intestinal biopsy

Amebiasis is uncommon in developed countries. Several case reports in the literature emphasize that both the presenting symptoms and the radiological findings of colonic amebiasis closely resemble more common conditions, such as idiopathic inflammatory bowel disease and gastro-intestinal malignancy. We describe a unique case of colonic amebiasis (amebomas) coexisting with signet-ring cell carcinoma of the ileocecal valve, the cecum and the appendix. Endoscopically, the ulcerated tumor was indistinguishable from the ulcerations and pseudotumors (amebomas) detected in the ascending colon. Histological examination of biopsy specimens revealed the pathognomonic features of protozoa with ingested erythrocytes in combination with signet-ring cell infiltration. The author concludes that amebiasis may not only mimic carcinoma but, rarely, may coexist with carcinoma in the same patient. Clinicians and pathologists should be aware of this possibility in order not to delay diagnosis and treatment of malignant disease.     

Primary signet ring cell carcinoma of the uterine cervix: A case report

Rationale:Primary signet ring cell carcinoma of the uterine cervix is extremely rare and the clinical characteristics and prognosis are not well known and there are no specific guidelines for treatment.Patient concerns:A 43-year-old woman was referred to our hospital for abnormal uterine bleeding lasting 1 month.Diagnoses:Histological examination revealed a signet ring cell carcinoma of the uterine cervix. After evaluation of extragenital origin, the patient was diagnosed International Federation of Gynecology and Obstetrics stage IIIC1 primary signet ring cell carcinoma or the uterine cervix.Intervention:The patient was prescribed concomitant chemo-radiation followed by intracavitary brachytherapy.Outcomes:She showed no evidence of disease after treatment but, it recurred after 7 months of last treatment.Lessons:Different approaches to diagnosis and treatment of this rare disease are needed and molecular pathological studies related to the onset of the disease are required.     

Signet ring cell carcinoma of the extrahepatic bile duct

Most tumors affecting the extrahepatic bile duct are adenocarcinomas; the other histologic types occur only rarely. We herein report the extremely rare case of signet ring cell carcinoma (SRCC) originating from the extrahepatic bile duct. A 55-year-old man was hospitalized for jaundice and pruritus. Computed tomography and positron emission tomography suggested the presence of distal extrahepatic bile-duct cancer. He underwent a pylorus preserving pancreaticoduodenectomy. A histologic study confirmed a signet ring cell neoplasm of the distal common bile duct. Because the upper resection margin was invaded by the tumor, he received postoperative concurrent chemoradiotherapy and four cycles of chemotherapy. The patient has survived with no evidence of recurrence for 2 years. This is the second case of primary SRCC of the distal extrahepatic bile duct reported in the literature; further reports of cases are warranted to determine the nature of SRCC in the extrahepatic bile duct.     

Multiorganic dissemination of a colorectal signet ring cell carcinoma with fulminant clinical course

Mucinous colorectal cancer with signet ring cell aspects is a rare form of adenocarcinoma representing about 2–5% of large bowel neoplasms. The tumor frequently presents with late-stage or peritoneal spreading. It can often affect young patients and diffusely infiltrate through all layers of the intestinal wall. Local recurrence and distant metastases are common in spite of surgical operation and adjuvant treatment, conditioning a poor prognosis. At the present, early diagnosis and complete resection are the most important approaches to improve the outcome. In our report we describe a case of a 41-yr-old patient with very aggressive untreated metastatic colorectal signet ring cell carcinoma. The fulminant tumor progression was really unexpected and misled every possible medical interpretation, leading to rapid worsening of the patient's clinical conditions and no chance for chemotherapy treatment. The tumor mimicked the picture observed in the acute leukemia, developing diffuse infiltration in all serosal membranes, liver, lung, kidneys, multiple lymph nodes, and meninges, as revealed by the post-mortem medical report.